[unreadable] [unreadable] Patients benefit from access to Internet-based health information and communication resources, but the maximum clinical benefit of consumer health informatics applications awaits integration of these tools with formal clinical services. Therefore, the purpose of this competing continuation is to expand our successful WWW-based information and communication network, HeartCare, from a patient-targeted home-care service to a technology enhanced- practice (TEP) that augments the clinical care provided by home care nurses with electronic information and communication resources. We will work with Aurora Health Care Systems, Milwaukee, WI to conduct a randomized field experiment. This extension of HeartCare will use human factors engineering design strategies to alter the original service with those deemed necessary to support the home care of patients with heart failure. This approach offers significant advantages over the emerging computerized passive home monitoring strategies by providing patients and nurses with relevant information and engaging patients in active self-monitoring and self-management. This study provides an opportunity to understand the context in which consumer health tools can be employed and the extent to which contextual factors affect the design of these tools. This revised proposal retains the original aims and scope of work and addresses three concerns raised by the BLRC: characterization of the intervention, explication of the design process, and clarification of the study period. In addition the revised budget request is 20% lower, reflecting the costs for a full 42-month project. We will undertake a design strategy consistent with sociotechnical systems theory and current approaches to implementation of information systems. We will first use techniques of industrial engineering to conduct a Work Analysis of the home care nurses' practice to (1) identify aspects of practice that could be enhanced by technology (2) better characterize the aspects of the clinical situation likely to be altered by the introduction of consumer health informatics tools. The industrial engineers, Aurora's expert cardiac nurses, and consumers will use the results of the work analysis to design a suite of electronic services including communication, personal health records, and educational materials. These services will integrate Aurora's evidence based heart failure care protocols. Next the TEP nurses will use local "practical" knowledge to plan how they will implement the TEP intervention into their practice. To equalize attention for the control group, electronic copies of nursing references and bulletin board services will be installed on their laptops. We will engage 600 nurse-patient dyads (60 nurses, 10 patients each) in a randomized field experiment. Key outcome variables include patient and nurse satisfaction with care, patient self-management, 30-day readmission rate and nurse workload. [unreadable] [unreadable]